The Components of Essential Newborn Care - basics

Table 1. Improving Newborn Health: The Essential Newborn Care ComponentsBeforeConceptionAntenatal PeriodAt and Soon after Birth (Up toabout Six Hours)Postnatal Period■ Adequate care ofthe female child,including nutrition,education, andhealth care.■ Immunization,including tetanustoxoid.■ Folatesupplementation.■ Birth spacing.■ Prevention ofsexuallytransmittedinfections (STIs).■ Avoidance ofsubstance abuse,includingavoidance ofsmoking andalcohol use.■ At least four visits with an emphasis on goalorientedor focused antenatal care.■ Tetanus toxoid.■ Iron and folate.■ Adequate nutritious diet.■ Extra rest.■ Consumption of iodized salt by the family.■ In areas where malaria is endemic:– Mother (later with the baby) sleeps underan insecticide-treated bednet; and– Mother takes intermittent presumptivetherapy.■ Detection and treatment of STIs such as syphilisand gonorrhea.■ Interventions for HIV/AIDS, including voluntarycounseling and testing.■ Birth preparedness:– Determination of place of delivery with thehealth care provider;– If home delivery: (a) adequate linen, washedand sun-dried—at least five pieces of clothfor delivery (may include a plastic sheet forthe mother); (b) clean new blade kept in itswrapper until the moment of use; and (c)clean cord ties. All these items should bekept in a clean container;– Setting aside of or arrangements to getmoney for going to a facility for planneddelivery or for emergencies in the motherand baby; and– Identification of the facility andtransportation to be used in case of anemergency.■ Early detection of problems or emergencies inthe mother and appropriate referral to and careseekingat a suitable facility.■ Treatment of problems in the mother.■ Skilled birth attendant following cleandelivery practices and supported byan enabling environment (skills,supplies, and suitable referralfacilities).■ Application of principles of theprevention of mother-to-childtransmission (PMTCT) of HIV/AIDSstrategy to the baby and the careprovider.■ Detection of problems andemergencies in the mother andappropriate referral and care-seeking.■ Treatment of problems in the mother.■ Essential preventive care of the baby:– Cleanliness and prevention ofinfection;– Temperature maintenance;– Eye care;– Cord care;– Early initiation of breastfeeding(within one hour) without prelactealfeeds, and advice forsubsequent, frequent exclusivebreastfeeding on demand day andnight; and– Extra care for the low birthweightbaby.■ Resuscitation at site of babies who donot breathe properly at birth.■ Detection and referral and appropriatecare-seeking for babies with dangersigns.■ Consultation(s) with mother and baby early in the first week, atleast once before day 3, and followed up as required.■ Continued essential preventive newborn care, includingsupport for exclusive breastfeeding on demand, temperaturemaintenance, cord care, etc.■ Continued application of inputs for PMTCT activities, includingfeeding and other support such as antiretroviral therapy,counseling, and nutrition.■ Postnatal vitamin A for the mother and continued use of ironand folate and intermittent therapy for malaria (where malariais endemic), according to recommendations of the Ministry ofHealth.■ Counseling for nutrition, family planning, and prevention andtreatment of STIs.■ Detection of danger signs and appropriate referral and careseeking.*The first four or five signs are more commonly used,especially in the community:– Poor sucking or not sucking;– Inactivity or lethargy—often denoted by families as“loose-limbed” in several languages;– Fever or hypothermia;– Respiratory distress;– Convulsions;– Vomiting;– Abdominal distension;– Severe umbilical infection (redness or swelling of the skinsurrounding the base of the cord or a foul smell); a slightpus discharge may often be considered a minor infectionthat can be treated locally;– Jaundice reaching the palms and soles;– Extensive pustules or skin infection; and– Swollen eyelids with pus discharge.■ Detection of minor problems, local treatment where necessary,and follow-up including referral, if needed, for:– Conjunctivitis;– Minor umbilical infection;– Pyoderma or skin infection;– Thrush; and– Jaundice.*Organizations or programs have selected different signs and varying numbers of signs; however, the fewer the danger signs, the easier it is for health workers to recall themand inform families if they occur. This prioritization of danger signs is useful, particularly for those working at peripheral centers and in communities.The Components of Essential Newborn Care 5